F 000 INITIAL COMMENTS F 000
COMPLAINT: NJ 100620, NJ 101005 CENSUS: 186
SAMPLE SIZE: 5
F 312 ADL CARE PROVIDED FOR DEPENDENT RESIDENTS
CFR(s): 483.24(a)(2)
(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.
This REQUIREMENT is not met as evidenced by:
F 312 7/26/17
SS=E
Complaint # NJ100620, NJ101005
Based on observation, interviews, review of medical records and pertinent facility
documentation, it was determined that the facility failed to provide timely toileting
assistance/incontinent care for 3 of 5 sampled residents (Resident #2, Resident #3, Resident
#5) and Unsampled Resident "A."
This deficient practice was evidenced by the following:
1. The surveyor reviewed the medical record of Resident #2 on 6/5/17 and 6/20/17. The Resident
"Admitting Face Sheet" revealed that Resident #2 was admitted to the facility in , with diagnoses which included but were not limited to:
.
Corrective Action
Nursing staff of residents #2, #3 and #5 and all nursing staff were in-serviced on revised ADL and toileting policy.
Residents are checked and/or changed as needed every 2 hours.
Identification of at risk residents All residents that need assistance with toileting or are incontinent are potentially at risk. They were identified by reviewing the residents care plans.
A random audit of 5 incontinent residents was performed by the DON/designee to ensure proper incontinent care is being provided.
Systemic Changes
The ADL and toileting policy has been revised to meet requirement and all
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
07/25/2017 Electronically Signed
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients . (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
F 312 Continued From page 1 F 312
According to the Minimum Data Set (MDS), an assessment tool, dated , Resident #2 had a Brief Interview for Mental Status (BIMS) score of
, which indicated intact cognition. Resident #2 required extensive assistance in all Activities of Daily Living (ADLs).
The surveyor conducted a care tour on 6/5/17 at 10:30 AM, with Registered Nurse (RN) #1.
Resident #2 was observed in bed with a
with intact skin.
During an interview with the surveyor on 6/5/17 at 12:01 PM, Resident #2 stated that he/she wakes up at approximately 5:00 AM - 6:00 AM. He/She is taken out of bed (OOB) between 10:30 AM - 11:00 AM and placed back to bed in the evening after dinner. The resident stated that in the past, he/she was transferred to bed after lunch at approximately 1:00 PM to receive care from the Certified Nursing Assistant (CNA). After rendering care, the CNA would then transfer the resident out of bed, where he/she would stay until after dinner in the evening.
As per Resident #2, currently;
. Resident #2 further stated that since the steady CNA left about 1 month ago, he/she is toileted 2 times a day.
According to Resident #2, I
According to Resident #2, "I am taken out of bed in the morning before lunch and put back to bed after dinner," and he/she is not changed during that time period while out of bed.
2. The surveyor reviewed the medical record of Resident #3 on 6/5/17. The Resident "Admitting
nursing staff were in-serviced on revised ADL and toileting policy.
The charge nurse and/ or designee conduct random incontinent audit of 5 residents per shift per month to ensure timely incontinent care.
Quality Assurance
The DON and/or designee will conduct random audits of 5 residents per month to ensure timely incontinent care and report findings to the administrator and QAPI committee at least quarterly.
F 312 Continued From page 2 F 312 Face Sheet" revealed that the resident was
admitted to the facility in , with diagnoses which included but were not limited to:
.
According to the MDS dated 1/25/17, Resident #3 had a BIMS score of which indicated intact cognition. Resident #3 required extensive assistance in all Activities of Daily Living (ADLs).
The surveyor observed Resident #3 in their room during a care tour on 6/5/17, at 10:40 AM.
Resident #3 refused to allow the surveyor to observe his/her brief.
During an interview with the surveyor on 6/5/17 at 11:30 AM, Resident #3 stated, that he/she can tell when they need to be toileted.
The resident further stated that he/she gets out of bed at all different hours, whenever they (the staff) are ready. According to Resident
#3, he/she returns to bed at approximately 2:00 PM for a nap. The staff are supposed to take him/her out of bed after the nap, for dinner, but that does not always occur. According to Resident #3, sometimes he/she is left in bed after their nap, causing them to eat their dinner meal alone in their room, which upsets the resident.
3. The surveyor reviewed the medical record of Resident #5 on 6/20/17. The Resident "Admitting Face Sheet" revealed that resident was admitted to the facility in with diagnoses which included but were not limited to:
F 312 Continued From page 3 F 312
According to the MDS dated , Resident #5 had a BIMS score of , which indicated
cognition. Resident #5 required extensive assistance in all Activities of Daily Living (ADLs).
During an interview with the surveyor on 6/20/17 at 11:50 AM, Resident #5 indicated that the staff members usually take him/her out of bed at approximately 10:30 AM, but if the staff are too busy, the resident does not get out of bed until 12:00 PM. Resident #5 further stated that if the staff change him/her at 2:00 PM, he/she is left in bed after being changed. According to Resident
#5, if he/she calls the staff for assistance, they will come 2 hours later. Staff "do not check or change me every 2 hours."
4. On 6/5/17 at 11:45 AM, the surveyor
interviewed Unsampled Resident "A." Unsampled Resident "A" stated that he/she was taken out of bed once a day and
The surveyor interviewed Licensed Practical Nurse (LPN) #1 on 6/5/17 at 1:52 PM. LPN #1 stated that the staff change residents, including residents who use a Hoyer lift to transfer, every 2 hours and as needed. According to LPN #1, the residents should not be left in bed. According to LPN #1, Resident #2 is alert and oriented, is changed every 2 hours, and is not left in bed after lunch.
The surveyor conducted an interview with LPN #2 on 6/20/17 at 3:17 PM. According to LPN #2; "If we are short staffed, we do not have [the]
resources to take [the resident out of bed] and put back [sic], so we keep them in bed after
F 312 Continued From page 4 F 312 lunch..."
The surveyor interviewed CNA #2 on 6/20/17 at 12:50 PM. As per CNA #2, the residents are changed every 2 hours. According to CNA #2, this morning Resident #5 got up at 10:45 AM, later than usual because the resident was assigned to another CNA, but requested that I care for him/her. CNA #2 further indicated that Resident
#5, is able to use , was not wet at 10:45 AM, and had not been changed yet.
The surveyor interviewed CNA #4 on 6/20/17 at 1:19 PM. CNA #4 stated, we "do 2 changes per shift and spot check them." The
Residents are changed first because they go to therapy. Residents who are changed before breakfast. [Resident #2]
, and is "changed before going into the chair, and at 1:30 PM."
The surveyor interviewed CNA #5 on 6/20/17 at 1:45 PM. CNA #5 stated, "We try to change the residents at least 2 times a shift...[Resident #2]
knows when he/she is wet and can tell us. CNA
#5 further stated that the unit is more demanding and it is tough with 2 CNAs. We do the best we can, but it will not be perfect. "This morning, I went to [Resident #2] at 10:15 AM. If we had a 3rd CNA, [Resident #2] would get care before that."
The surveyor reviewed the facility
"Policy/Procedure Assist with ADL and Personal Hygiene/Grooming" dated 2/15/16. The following information was observed:
"Policy: It is policy of (Facility name) to assist residents with personal hygiene and grooming when the resident is unable to help themselves.
F 312 Continued From page 5 F 312 (sic)
Procedure: 5. Residents who are incontinent will be changed every two hours and as needed. The areas of skin affected will be washed, dried and a moisture barrier applied."
NJAC 8:39-27.1(e)
